Patients Forms & Information
For your convenience, please find a list of forms below. Please print them off and bring them to your appointment.
• Insurance Card
• HIPAA Acknowledgment Form
• HIPAA Authorization Form
• Medical History
• Patient Information Form
• Records Request from East Main Dental Center
• Records Request to East Main Dental Center
We have a Treatment Coordinator available to assist our patients with any questions and to make financial arrangements for the dental treatment needs. Base on a patient’s credit history we have a wide variety of options of payment plans within our office, or outside financing including CareCredit.
We offer a cash discount for paying in full at the time of service. We offer a senior discount for patients over the age of 60.
We have the Short Call Club for hygiene appointments, offering a 20% discount for patients current on the hygiene recall, with a flexible schedule and able to pay in full for the hygiene appointment.